GRACE USMAN
Subscriber on policy B10M000015
Claims
2
Attributed to this person
Charged
936.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
129.60
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | GRACE USMAN |
| Role on the policy | Subscriber |
| Policy | B10M000015 |
| Date of birth | 29 Dec 1976 |
| Plan | PLATINUM PPO |
| Covered from | 9 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 129.60 |
| Total | 129.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000058 | 13 Jul 2026 | 288.00 | CASCADE CARE | Not denied | — |
| CLM0000057 | 22 Nov 2024 | 648.00 | CASCADE CARE | Not denied | — |